Guest editorial: Farewell Kent Spackman

Written by Michael Osborne on 18 December 2014.

I couldn’t let December pass without highlighting a major challenge for the world of health informatics. Kent Spackman has been the major force behind SNOMED since 1997. In October 2014 Kent announced to the world that he is standing down from his position at the International Health Terminology Standards Development Organisation (IHTSDO) as Chief Terminologist (IHTSDO, 2014). Kent is retiring as of 1st January 2015[1]. What does this mean for us?

Let me step back and explain what SNOMED CT is and why it is important. SNOMED CT allows health systems to seamlessly interchange the meaning of data elements. The meaning is modelled into the terminology. How can something as complex as bacterial infection of the lung be meaningfully modelled? All of the lower level components such as anatomy, bacteria and pathogenic processes are also defined into the terminology. A bit like LEGO, these low level attributes are combined in logical statements to define the concepts, of which there are over 300,000.

At a recent meeting in Amsterdam it was highlighted to me how important the SNOMED CT reference terminology is in terms of integration between enterprises. Denmark has recently implemented a national microbial surveillance database (MiBa). In her talk[2], Marianne highlighted the challenges of mapping microorganism results from 12 different regional labs, all with their own local codes for every bug. At the meeting was a health informatician from Biomerieux , a company that produces the major share of bacterial identification and susceptibility equipment used in labs today. Biomerieux is looking at whether they can code the organisms identified by instruments such as Vitek 2 and Vitek MS in SNOMED CT so that this mapping is done once and not repeated, at great expense, everywhere.

In Australia, SNOMED CT is content is managed by the National eHealth transitory Authority (NEHTA) who have a small team of dedicated clinical terminologists . Australia is one of the founding member countries having originally helped to set up the IHTSDO in 2007. Australia has some of the most cutting edge SNOMED CT development tooling in the world thanks to collaboration between the CSIRO and NEHTA. The recently developed LINGO[3] web tools are making it easier to develop both the Australian extension to SNOMED CT and the Australian Medicines Terminology (AMT) which is based on SNOMED CT.

As I mentioned, one of the LEGO blocks in SNOMED CT is the Anatomy hierarchy. It is a direct dependency for many other concepts from Diseases/Disorders, Procedures and Observations. The current anatomy model in SNOMED CT has many problems[4]. Some of these critical issues have since been corrected, however the structure of the anatomy hierarchy is difficult to maintain, and is inconsistent. It is one of Kent’s many projects to make anatomy model simpler and correct the inconsistencies. He has been working on it since 2010 and the current alpha release of anatomy redesign is up to version 21. My concern is that this may be very difficult for someone else to pick up and run with when Kent retires.

Anatomy redesign is just one of 700 content improvement projects at the time of writing that IHTSDO has open on the collabNet project tracker[5]. Many of these have a heavy reliance on Kent as Chief Terminologist. Kent’s vast knowledge of SNOMED CT and Medical Informatics in general will be hard to replace. To quote the Kent Spackman retirement press release:

“In recent times he has been central to harmonization activities between IHTSDO and WHO and in the development of the linkage between SNOMED CT and ICD-11. He has also taken a lead role on behalf of IHTSDO in the harmonization of SNOMED CT and LOINC, ensuring greater interoperability between both global standards."

IHTSDO has made a number of steps towards a more responsive corporate business model. They have implemented a hew helpdesk called FreshDesk.[6] They have recently employed a number of new terminologists and staff to help member countries with implementation and design tools, such as the IHTSDO SNOMED CT browser[7]. They have trained consultant terminologists from all across the world to help with the burden of maintaining this massive terminology.

As Don Sweete, CEO of IHTSDO says “It is our task now to take up the challenge and continue with his vision and work.”

I, for one, am hoping that the new IHTSDO structure is up to this challenge.